Laverman Gozewÿn, Ruggenenti Piero, Remuzzi Giuseppe
Martini Hospital, Department of Internal Medicine, Groningen, The Netherlands.
Curr Hypertens Rep. 2003 Oct;5(5):364-7. doi: 10.1007/s11906-003-0080-3.
Hypertension increases the renal and cardiovascular risks in diabetic patients. The beneficial effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on renal and cardiovascular outcomes are discussed in this paper, with a particular focus on their optimal use in the hypertensive diabetic patient, with or without evidence of renal or cardiovascular disease. Although the mechanism of action of the two drug classes is not entirely similar, there is no evidence of differences in their clinical effects. Importantly, the achieved risk reduction with either drug is not similar across subsets of diabetic patients. Overt nephropathy of type 2 diabetes appears poorly responsive even to maximized renin-angiotensin system inhibition. This urgently calls for new interventions that may decrease renal and cardiovascular risk through other mechanisms than blood pressure lowering alone. Improving the outcome of type 2 diabetics is the major clinical challenge for the beginning of the third millennium.
高血压会增加糖尿病患者的肾脏和心血管疾病风险。本文讨论了血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂对肾脏和心血管结局的有益作用，特别关注它们在有或无肾脏或心血管疾病证据的高血压糖尿病患者中的最佳使用。尽管这两类药物的作用机制并不完全相似，但没有证据表明它们的临床效果存在差异。重要的是，在不同亚组的糖尿病患者中，使用这两种药物所实现的风险降低并不相同。2型糖尿病的显性肾病似乎即使在肾素-血管紧张素系统抑制最大化的情况下反应也很差。这迫切需要新的干预措施，这些措施可能通过单独降低血压以外的其他机制来降低肾脏和心血管疾病风险。改善2型糖尿病患者的结局是第三个千年伊始的主要临床挑战。
